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Buto PT, Wang J, La Joie R, Zimmerman SC, Glymour MM, Ackley SF, Hoffmann TJ, Yaffe K, Zeki Al Hazzouri A, Brenowitz WD. Genetic risk score for Alzheimer's disease predicts brain volume differences in mid and late life in UK biobank participants. Alzheimers Dement 2024; 20:1978-1987. [PMID: 38183377 PMCID: PMC10984491 DOI: 10.1002/alz.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/18/2023] [Accepted: 11/26/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION We estimated the ages when associations between Alzheimer's disease (AD) genes and brain volumes begin among middle-aged and older adults. METHODS Among 45,616 dementia-free participants aged 45-80, linear regressions tested whether genetic risk score for AD (AD-GRS) had age-dependent associations with 38 regional brain magnetic resonance imaging volumes. Models were adjusted for sex, assessment center, genetic ancestry, and intracranial volume. RESULTS AD-GRS modified the estimated effect of age (per decade) on the amygdala (-0.41 mm3 [-0.42, -0.40]); hippocampus (-0.45 mm3 [-0.45, -0.44]), nucleus accumbens (-0.55 mm3 [-0.56, -0.54]), thalamus (-0.38 mm3 [-0.39, -0.37]), and medial orbitofrontal cortex (-0.23 mm3 [-0.24, -0.22]). Trends began by age 45 for the nucleus accumbens and thalamus, 48 for the hippocampus, 51 for the amygdala, and 53 for the medial orbitofrontal cortex. An AD-GRS excluding apolipoprotein E (APOE) was additionally associated with entorhinal and middle temporal cortices. DISCUSSION APOE and other genes that increase AD risk predict lower hippocampal and other brain volumes by middle age.
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Affiliation(s)
- Peter T. Buto
- Department of Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Jingxuan Wang
- Department of Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Renaud La Joie
- Memory and Aging CenterUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Scott C. Zimmerman
- Department of Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - M. Maria Glymour
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Sarah F. Ackley
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Thomas J. Hoffmann
- Department of Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Kristine Yaffe
- Department of Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Departments of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Departments of NeurologyUniversity of CaliforniaSan FranciscoUSA
| | - Adina Zeki Al Hazzouri
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Willa D. Brenowitz
- Department of Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Kaiser Permanente Center for Health ResearchPortlandOregonUSA
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Kamath V, Jiang K, Manning KJ, Mackin RS, Walker KA, Powell D, Lin FR, Chen H, Brenowitz WD, Yaffe K, Simonsick EM, Deal JA. Olfactory Dysfunction and Depression Trajectories in Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 2024; 79:glad139. [PMID: 37357824 PMCID: PMC10733184 DOI: 10.1093/gerona/glad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND We examined the relationship between baseline olfactory performance and incident significant depressive symptoms and longitudinal depression trajectories in well-functioning older adults. Inflammation and cognitive status were examined as potential mediators. METHODS Older adults (n = 2 125, 71-82 years, 51% female, 37% Black) completed an odor identification task at Year 3 (our study baseline) of the Health, Aging, and Body Composition study. Cognitive assessments, depressive symptoms, and inflammatory markers were ascertained across multiple visits over 8 years. Discrete-time complementary log-log models, group-based trajectory models, and multivariable-adjusted multinomial logistic regression were employed to assess the relationship between baseline olfaction and incident depression and longitudinal depression trajectories. Mediation analysis assessed the influence of cognitive status on these relationships. RESULTS Individuals with lower olfaction had an increased risk of developing significant depressive symptoms at follow-up (hazard ratio = 1.04, 95% confidence interval [CI]: 1.00, 1.08). Of the 3 patterns of longitudinal depression scores identified (stable low, stable moderate, and stable high), poorer olfaction was associated with a 6% higher risk of membership in the stable moderate (relative risk ratio [RRR] = 1.06, 95% CI: 1.02, 1.10)/stable high (RRR = 1.06, 95% CI: 1.00, 1.12) groups, compared to the stable low group. Poor cognitive status, but not inflammation, partially mediated the relationship between olfactory performance and incident depression symptom severity. CONCLUSIONS Suboptimal olfaction could serve as a prognostic indicator of vulnerability for the development of late-life depression. These findings underscore the need for a greater understanding of olfaction in late-life depression and the demographic, cognitive, and biological factors that influence these relationships over time.
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Affiliation(s)
- Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kening Jiang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kevin J Manning
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - R Scott Mackin
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- San Francisco VA Medical Center, San Francisco, California, USA
| | - Keenan A Walker
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Danielle Powell
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Willa D Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Kristine Yaffe
- San Francisco VA Medical Center, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Eleanor M Simonsick
- Longitudinal Studies Section, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Qian H, Khadka A, Martinez SM, Singh S, Brenowitz WD, Zeki Al Hazzouri A, Hill-Jarrett TG, Glymour MM, Vable AM. Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older. JAMA Netw Open 2023; 6:e2344186. [PMID: 37988079 PMCID: PMC10663972 DOI: 10.1001/jamanetworkopen.2023.44186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/10/2023] [Indexed: 11/22/2023] Open
Abstract
Importance Despite existing federal programs to increase access to food, food insecurity is common among US older adults. Food insecurity may affect Alzheimer disease and Alzheimer disease-related dementias via multiple mechanisms, yet there is almost no quantitative research evaluating this association. Objective To examine whether food insecurity in older adults is associated with later-life cognitive outcomes. Design, Setting, and Participants This cohort study of US residents aged 50 years and older from the US Health and Retirement Study was restricted to respondents with food insecurity data in 2013 and cognitive outcome data between calendar years 2014 and 2018. Analyses were conducted from June 1 to September 22, 2023. Exposure Food insecurity status in 2013 was assessed using the validated US Department of Agriculture 6-item Household Food Security Module. Respondents were classified as being food secure, low food secure, and very low food secure. Main Outcomes and Measures Outcomes were dementia probability and memory score (standardized to 1998 units), estimated biennially between 2014 and 2018 using a previously validated algorithm. Generalized estimation equations were fit for dementia risk and linear mixed-effects models for memory score, taking selective attrition into account through inverse probability of censoring weights. Results The sample consisted of 7012 participants (18 356 person-waves); mean (SD) age was 67.7 (10.0) years, 4131 (58.9%) were women, 1136 (16.2%) were non-Hispanic Black, 4849 (69.2%) were non-Hispanic White, and mean (SD) duration of schooling was 13.0 (3.0) years. Compared with food-secure older adults, experiencing low food security was associated with higher odds of dementia (odds ratio, 1.38; 95% CI, 1.15-1.67) as was experiencing very low food security (odds ratio, 1.37; 95% CI, 1.11-1.59). Low and very low food security was also associated with lower memory levels and faster age-related memory decline. Conclusions and Relevance In this cohort study of older US residents, food insecurity was associated with increased dementia risk, poorer memory function, and faster memory decline. Future studies are needed to examine whether addressing food insecurity may benefit brain health.
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Affiliation(s)
- Haobing Qian
- Department of Family and Community Medicine, University of California, San Francisco
| | - Aayush Khadka
- Department of Family and Community Medicine, University of California, San Francisco
| | - Suzanna M. Martinez
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Sonali Singh
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | | | - M. Maria Glymour
- Department of Epidemiology, Boston University, Boston, Massachusetts
| | - Anusha M. Vable
- Department of Family and Community Medicine, University of California, San Francisco
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Ospina-Romero M, Brenowitz WD, Glymour MM, Westrick A, Graff RE, Hayes-Larson E, Mayeda ER, Ackley SF, Kobayashi LC. Education, incident cancer, and rate of memory decline in a national sample of US adults in mid-to-later-life. J Geriatr Oncol 2023; 14:101530. [PMID: 37210786 DOI: 10.1016/j.jgo.2023.101530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/30/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Middle-aged and older adults who develop cancer experience memory loss following diagnosis, but memory decline in the years before and after cancer diagnosis is slower compared to their cancer-free counterparts. Educational attainment strongly predicts memory function during aging, but it is unclear whether education protects against memory loss related to cancer incidence or modifies long-term memory trajectories in middle-aged and older cancer survivors. MATERIALS AND METHODS Data were from 14,449 adults (3,248 with incident cancer, excluding non-melanoma skin cancer) aged 50+ in the population-based US Health and Retirement Study from 1998 to 2016. Memory was assessed every two years as a composite of immediate and delayed word recall tests and proxy assessments for impaired individuals. Memory scores all time points were standardized at to the baseline distribution. Using multivariate-adjusted linear mixed-effects models, we estimated rates of memory decline in the years before cancer diagnosis, shortly after diagnosis, and in the years after diagnosis. We compared rates of memory decline between incident cancer cases and age-matched cancer-free adults, overall and according to level of education (<12 years, "low"; 12 to <16 years, "intermediate"; ≥16 years, "high"). RESULTS Incident cancer diagnoses were followed by short-term declines in memory averaging 0.06 standard deviation (SD) units (95% confidence interval [CI]: -0.084, -0.036). Those with low education experienced the strongest magnitude of short-term decline in memory after diagnosis (-0.10 SD units, 95% CI: -0.15, -0.05), but this estimate was not statistically significantly different from the short-term decline in memory experienced by those with high education (-0.04 SD units, 95% CI: -0.08, 0.01; p-value for education as an effect modifier = 0.15). In the years prior to and following an incident cancer diagnosis, higher educational attainment was associated with better memory, but it did not modify the difference in rate of long-term memory decline between cancer survivors and those who remained cancer-free. DISCUSSION Education was associated with better memory function over time among both cancer survivors and cancer-free adults aged 50 and over. Low education may be associated with a stronger short-term decline in memory after a cancer diagnosis.
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Affiliation(s)
- Monica Ospina-Romero
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America; Department of Pathology and Laboratory Medicine, University of Wisconsin, United States of America.
| | - Willa D Brenowitz
- Department of Psychiatry, University of California San Francisco, United States of America; Kaiser Permanente Center for Health Research, Portland, United States of America
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Ashly Westrick
- Department of Epidemiology, School of Public Health, University of Michigan, United States of America
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Eleanor Hayes-Larson
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, United States of America
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, United States of America
| | - Sarah F Ackley
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Lindsay C Kobayashi
- Department of Epidemiology, School of Public Health, University of Michigan, United States of America
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Brenowitz WD, Fornage M, Launer LJ, Habes M, Davatzikos C, Yaffe K. Alzheimer's Disease Genetic Risk, Cognition, and Brain Aging in Midlife. Ann Neurol 2023; 93:629-634. [PMID: 36511390 PMCID: PMC9974745 DOI: 10.1002/ana.26569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/10/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
We examined associations of an Alzheimer's disease (AD) Genetic Risk Score (AD-GRS) and midlife cognitive and neuroimaging outcomes in 1,252 middle-aged participants (311 with brain MRI). A higher AD-GRS based on 25 previously identified loci (excluding apolipoprotein E [APOE]) was associated with worse Montreal Cognitive Assessment (-0.14 standard deviation [SD] [95% confidence interval {CI}: -0.26, -0.02]), older machine learning predicted brain age (2.35 years[95%CI: 0.01, 4.69]), and white matter hyperintensity volume (0.35 SD [95% CI: 0.00, 0.71]), but not with a composite cognitive outcome, total brain, or hippocampal volume. APOE ε4 allele was not associated with any outcomes. AD risk genes beyond APOE may contribute to subclinical differences in cognition and brain health in midlife. ANN NEUROL 2023;93:629-634.
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Affiliation(s)
- Willa D Brenowitz
- Departments of Psychiatry and Behavioral Sciences, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Myriam Fornage
- The University of Texas, Health Science Center at Houston, Houston, Texas, USA
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland, USA
| | - Mohamad Habes
- Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging Core, Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christos Davatzikos
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristine Yaffe
- Departments of Psychiatry and Behavioral Sciences, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- San Francisco VA Medical Center, San Francisco, California, USA
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Brenowitz WD, Yaffe K. Observational studies in Alzheimer disease: bridging preclinical studies and clinical trials. Nat Rev Neurol 2022; 18:747-757. [PMID: 36316487 PMCID: PMC9894623 DOI: 10.1038/s41582-022-00733-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/29/2022]
Abstract
Recent high-profile failures of Alzheimer disease treatments at the clinical trial stage have led to renewed efforts to identify and test novel interventions for Alzheimer disease and related dementias (ADRD). In this Perspective, we highlight the importance of including well-designed observational studies as part of these efforts. Observational research is an important cornerstone for gathering evidence on risk factors and causes of ADRD; this evidence can then be combined with data from preclinical studies and randomized controlled trials to inform the development of effective interventions. Observational study designs can be particularly beneficial for hypothesis generation, posing questions that are unethical or impractical for a trial setting, studying life-course associations, research in populations typically not included in trials, and public health surveillance. Here, we discuss each of these situations in the specific context of ADRD research. We also highlight novel approaches to enhance causal inference and provide a timely discussion on how observational epidemiological studies help provide a bridge between preclinical studies and successful interventions for ADRD.
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Affiliation(s)
- Willa D Brenowitz
- Departments of Psychiatry and Behavioral Sciences, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Kristine Yaffe
- Departments of Psychiatry and Behavioral Sciences, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
- San Francisco VA Medical Center, San Francisco, CA, USA.
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Buto P, Swinnerton KN, La Joie R, Zimmerman SC, Glymour MM, Ackley SF, Brenowitz WD. Genetic Risk Score for Alzheimer’s Disease Predicts Brain Volume Differences in Mid‐ and Late‐life in UK Biobank Participants. Alzheimers Dement 2022. [DOI: 10.1002/alz.066409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Renaud La Joie
- Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco San Francisco CA USA
| | | | | | - Sarah F Ackley
- University of California, San Francisco San Francisco CA USA
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Armstrong NM, Vieira Ligo Teixeira C, Gendron C, Brenowitz WD, Lin FR, Swenor B, Powell DS, Deal JA, Simonsick EM, Jones RN. Associations of dual sensory impairment with long-term depressive and anxiety symptoms in the United States. J Affect Disord 2022; 317:114-122. [PMID: 35932940 PMCID: PMC10696594 DOI: 10.1016/j.jad.2022.07.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We explored the associations of dual sensory impairment (DSI) with long-term depressive and anxiety symptoms as well as low perceived social support (LPSS) as a modifier of these associations. METHODS Multinomial logistic regression models were used to examine the associations of DSI and single sensory impairment (hearing [pure-tone average > 25 dB] and vision [impaired visual acuity and/or contrast sensitivity]) with long-term depressive symptom (≥8 on the 10-item Center for Epidemiologic Studies-Depression Scale) and anxiety symptom (present on the Hopkins Symptom Checklist) latent classes from group-based trajectory models (rare/never; mild/moderate increasing; chronically high) among 2102 Health, Aging and Body Composition Study participants (mean age:74.0 ± 2.8 years; 51.9 % female) over 10 years. Models were adjusted by demographic characteristics and cardiovascular risk factors, and LPSS. An additional model evaluated the two-way interaction between DSI and LPSS. RESULTS DSI was associated with increased risk of being chronically depressed (Risk Ratio, RR = 1.99, 95 % Confidence Interval, CI: 1.25, 3.17), not mild/moderate increasingly depressed (RR = 1.25, 95 % CI: 0.91, 1.71). DSI had increased risk of being mild/moderate increasingly anxious (RR = 1.60, 95 % CI: 1.16, 2.19) and chronically anxious (RR = 1.86, 95 % CI: 1.05, 3.27) groups, as compared to no impairments. Hearing impairment was associated with being mild/moderate increasingly anxious (RR = 1.34, 95 % CI: 1.01, 1.79). No other associations were found for single sensory impairments. LPSS did not modify associations. LIMITATIONS Sensory measures were time-fixed, and LPSS, depression and anxiety measures were self-reported. CONCLUSIONS Future research is warranted to determine if DSI therapies may lessen long-term chronically high depressive and anxiety symptoms.
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Affiliation(s)
- Nicole M Armstrong
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | | | - Colby Gendron
- Department of Economics, Brown University, Providence, RI, USA
| | - Willa D Brenowitz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bonnelin Swenor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Disability Health Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Danielle S Powell
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Duchowny KA, Ackley SF, Brenowitz WD, Wang J, Zimmerman SC, Caunca MR, Glymour MM. Associations Between Handgrip Strength and Dementia Risk, Cognition, and Neuroimaging Outcomes in the UK Biobank Cohort Study. JAMA Netw Open 2022; 5:e2218314. [PMID: 35737388 PMCID: PMC9227006 DOI: 10.1001/jamanetworkopen.2022.18314] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE The associations between muscle strength and cognitive outcomes have sparked interest in interventions that increase muscle strength for prevention of dementia, but the associations between muscle strength and cognitive aging are unclear, particularly among middle-aged adults. OBJECTIVE To evaluate the association between handgrip strength (HGS) and dementia, reduced cognition, and poorer neuroimaging outcomes in a UK population of middle-aged adults. DESIGN, SETTING, AND PARTICIPANTS This cohort study evaluated UK Biobank participants aged 39 to 73 years enrolled from 2006 to 2010 with measured HGS and prospectively followed up for dementia diagnosis. Data were analyzed from October 2021 to April 2022. EXPOSURES HGS assessed in both hands via dynamometer. MAIN OUTCOMES AND MEASURES Outcomes included cognitive test scores (fluid intelligence and prospective memory), brain magnetic resonance imaging measures (total brain volume, white matter hyperintensity, and hippocampal volume), and incident dementia (all-cause, vascular, and Alzheimer disease [AD] from primary care, hospital, or death records) over a median (IQR) of 11.7 (11.0-12.4) years of follow-up. Mixed-effects linear and logistic regressions and Cox proportional-hazard models were used to estimate associations, stratified by gender and adjusted for covariates. Estimates are presented per 5-kg decrement in HGS. To evaluate reverse causation, we assessed whether a polygenic risk score for AD is associated with HGS. RESULTS A subsample of 190 406 adult participants in the UK Biobank (mean [SD] age, 56.5 [8.1] years; 102 735 women [54%]) were evaluated. A 5-kg decrement in HGS was associated with lower fluid intelligence scores in men (β, -0.007; 95% CI, -0.010 to -0.003) and women (β, -0.04; 95% CI, -0.05 to -0.04. A 5-kg decrement in HGS was associated with worse odds of correctly responding to a prospective memory task for men (odds ratio, 0.91; 95% CI, 0.90 to 0.92) and women (odds ratio, 0.88; 95% CI, 0.87 to 0.90). A 5-kg decrement in HGS was associated with greater white matter hyperintensity volume in men (β, 92.22; 95% CI, 31.09 to 153.35) and women (β, 83.56; 95% CI, 13.54 to 153.58). A 5-kg decrement in HGS was associated with incident dementia for men (hazard ratio, 1.20; 95% CI, 1.12 to 1.28) and women (hazard ratio, 1.12; 95% CI, 1.00 to 1.26). The AD genetic risk score was not significantly associated with HGS. CONCLUSIONS AND RELEVANCE These findings suggest that HGS is associated with measures of neurocognitive brain health among men and women and they add to a growing body of research indicating that interventions designed to increase muscle strength, particularly among middle-aged adults, may hold promise for the maintenance of neurocognitive brain health.
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Affiliation(s)
- Kate A. Duchowny
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Sarah F. Ackley
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Willa D. Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Jingxuan Wang
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Scott C. Zimmerman
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Brenowitz WD, Robbins NM, Strotmeyer ES, Yaffe K. Associations of Lower Extremity Peripheral Nerve Impairment and Risk of Dementia in Black and White Older Adults. Neurology 2022; 98:e1837-e1845. [PMID: 35264428 PMCID: PMC9109146 DOI: 10.1212/wnl.0000000000200185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/26/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Peripheral nerve impairments and dementia are common among older adults and share risk factors. However, few studies have examined whether peripheral nerve function and dementia are associated. We evaluated whether lower extremity peripheral nerve impairments were associated with higher incidence of dementia and whether associations differed by comorbidity subgroups (diabetes, low vitamin B12, and APOE ε4 allele carriers). METHODS We studied Black and White Health, Aging, and Body Composition Study participants 70 to 79 years of age and without dementia at enrollment. Lower extremity sensory and motor peripheral nerve function was measured at year 4 (the analytic baseline of this study). Sensory nerve impairments were measured with monofilament (1.4 g, 10 g) and vibration threshold of the toe. Monofilament insensitivity was defined as unable to detect monofilament (3 of 4 touches), and vibration detection impairment was defined as >130 μm. Fibular motor impairments were defined as <1 mV compound motor action potential (CMAP) amplitude and slow nerve conduction velocity <40 m/s. Incident dementia over the following 11 years was determined from medical records, cognitive scores, and medications. Cox proportional hazard models adjusted for demographics and health conditions assessed associations of nerve impairments with incident dementia. RESULTS Among 2,174 participants (52% women, 35% Black), 45% could not detect monofilament 1.4 g, 9% could not detect monofilament 10 g, 6% could not feel vibration, 10% had low CMAP amplitude, and 24% had slow conduction velocity. Monofilament 10 g (hazard ratio [HR] 1.35, 95% CI 0.99-1.84) and vibration detection insensitivity (HR 1.73, 95% CI 1.24-2.40) were associated/borderline associated with a higher risk of dementia after covariate adjustment. Estimates were elevated but not significant for monofilament 1.4 g, CMAP amplitude, and conduction velocity (p > 0.05). Increasing number of peripheral nerve impairments was associated with higher risk of dementia in a graded fashion; for ≥3 impairments, the HR was 2.37 (95% CI 1.29-4.38). In subgroup analyses, effect estimates were generally higher among those with diabetes, low vitamin B12, and APOE ε4 allele except for vibration detection. DISCUSSION Peripheral nerve impairments, especially sensory, were associated with a higher risk of dementia even after adjustment for age and other health factors. These associations may represent a shared susceptibility to nervous system degeneration.
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Affiliation(s)
- Willa D Brenowitz
- From the Departments of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Epidemiology (W.D.B., K.Y.), Biostatistics (W.D.B., K.Y.), and Neurology (K.Y.), University of California San Francisco, San Francisco; Department of Neurology (N.M.R.), Geisel School of Medicine, Dartmouth, Hannover, NH; Department of Epidemiology (E.S.S.), University of Pittsburgh, PA; and San Francisco VA Medical Center (K.Y.), CA
| | - Nathaniel M Robbins
- From the Departments of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Epidemiology (W.D.B., K.Y.), Biostatistics (W.D.B., K.Y.), and Neurology (K.Y.), University of California San Francisco, San Francisco; Department of Neurology (N.M.R.), Geisel School of Medicine, Dartmouth, Hannover, NH; Department of Epidemiology (E.S.S.), University of Pittsburgh, PA; and San Francisco VA Medical Center (K.Y.), CA
| | - Elsa S Strotmeyer
- From the Departments of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Epidemiology (W.D.B., K.Y.), Biostatistics (W.D.B., K.Y.), and Neurology (K.Y.), University of California San Francisco, San Francisco; Department of Neurology (N.M.R.), Geisel School of Medicine, Dartmouth, Hannover, NH; Department of Epidemiology (E.S.S.), University of Pittsburgh, PA; and San Francisco VA Medical Center (K.Y.), CA
| | - Kristine Yaffe
- From the Departments of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Epidemiology (W.D.B., K.Y.), Biostatistics (W.D.B., K.Y.), and Neurology (K.Y.), University of California San Francisco, San Francisco; Department of Neurology (N.M.R.), Geisel School of Medicine, Dartmouth, Hannover, NH; Department of Epidemiology (E.S.S.), University of Pittsburgh, PA; and San Francisco VA Medical Center (K.Y.), CA
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11
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Zimmerman SC, Brenowitz WD, Calmasini C, Ackley SF, Graff RE, Asiimwe SB, Staffaroni AM, Hoffmann TJ, Glymour MM. Association of Genetic Variants Linked to Late-Onset Alzheimer Disease With Cognitive Test Performance by Midlife. JAMA Netw Open 2022; 5:e225491. [PMID: 35377426 PMCID: PMC8980909 DOI: 10.1001/jamanetworkopen.2022.5491] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Identifying the youngest age when Alzheimer disease (AD) influences cognition and the earliest affected cognitive domains will improve understanding of the natural history of AD and approaches to early diagnosis. OBJECTIVE To evaluate the age at which cognitive differences between individuals with higher compared with lower genetic risk of AD are first apparent and which cognitive assessments show the earliest difference. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from UK Biobank participants of European genetic ancestry, aged 40 years or older, who contributed genotypic and cognitive test data from January 1, 2006, to December 31, 2015. Data analysis was performed from March 10, 2020, to January 4, 2022. EXPOSURE The AD genetic risk score (GRS), which is a weighted sum of 23 single-nucleotide variations. MAIN OUTCOMES AND MEASURES Seven cognitive tests were administered via touchscreen at in-person visits or online. Cognitive domains assessed included fluid intelligence, episodic memory, processing speed, executive functioning, and prospective memory. Multiple cognitive measures were derived from some tests, yielding 32 separate measures. Interactions between age and AD-GRS for each of the 32 cognitive measures were tested with linear regression using a Bonferroni-corrected P value threshold. For cognitive measures with significant evidence of age by AD-GRS interaction, the youngest age of interaction was assessed with new regression models, with nonlinear specification of age terms. Models with youngest age of interaction from 40 to 70 years, in 1-year increments, were compared, and the best-fitting model for each cognitive measure was chosen. Results across cognitive measures were compared to determine which cognitive indicators showed earliest AD-related change. RESULTS A total of 405 050 participants (mean [SD] age, 57.1 [7.9] years; 54.1% female) were included. Sample sizes differed across cognitive tests (from 12 455 to 404 682 participants). The AD-GRS significantly modified the association with age on 13 measures derived from the pairs matching (range in difference in mean cognition per decade increase in age for 1-SD higher AD-GRS, 2.5%-11.5%), symbol digit substitution (range in difference in mean cognition per decade increase in age for 1-SD higher AD-GRS, 2.0%-5.8%), and numeric memory tests (difference in mean cognition per decade increase in age for 1-SD higher AD-GRS, 8.8%) (P = 1.56 × 10-3). Best-fitting models suggested that cognitive scores of individuals with a high vs low AD-GRS began to diverge by 56 years of age for all 13 measures and by 47 years of age for 9 measures. CONCLUSIONS AND RELEVANCE In this cross-sectional study, by early midlife, subtle differences in memory and attention were detectable among individuals with higher genetic risk of AD.
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Affiliation(s)
- Scott C. Zimmerman
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Willa D. Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Camilla Calmasini
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Sarah F. Ackley
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Rebecca E. Graff
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Stephen B. Asiimwe
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Adam M. Staffaroni
- Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California, San Francisco
| | - Thomas J. Hoffmann
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Institute for Human Genetics, University of California, San Francisco
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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12
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Armstrong NM, Vieira Ligo Teixeira C, Gendron C, Brenowitz WD, Lin FR, Swenor B, Deal JA, Simonsick EM, Jones RN. Associations of dual sensory impairment with incident mobility and ADL difficulty. J Am Geriatr Soc 2022; 70:1997-2007. [PMID: 35343588 DOI: 10.1111/jgs.17764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a dearth of studies examining the associations of objectively measured dual sensory impairment (DSI) with incident mobility and activities of daily life (ADL) difficulty longitudinally. METHODS Cox proportional hazards models were used to examine the associations of DSI and single sensory impairment (hearing, vision) with incident mobility difficulty (many problems or inability to walk ¼ mile and/or climb 10 steps) and ADL difficulty up to six years of follow-up among 2020 participants of the Health, Aging, and Body Composition Study, a cohort of older adults aged 70-79 years from Pittsburgh, PA and Memphis, TN. Vision impairment (VI) was defined as impaired visual acuity (20/50 or worse on Bailey-Lovie distance test) and contrast sensitivity (<1.3 log units on Pelli-Robson test), and hearing impairment (HI) was defined as pure-tone average in better-hearing ear >25 decibels. Models were adjusted by age, race, sex, education, diabetes, depressive symptoms, hypertension, gait speed from 20-meter walk, global cognition score, prevalent cardiovascular disease, and body mass index. RESULTS There were 23% with DSI (n = 459). DSI was associated with increased risk of both incident report of mobility (hazard ratio [HR] = 2.25, 95% confidence interval [CI]: 1.47, 3.43), and ADL difficulty (HR = 2.26, 95% CI: 1.50, 3.40). Neither VI nor HI alone was associated with risk of either outcome. CONCLUSIONS DSI is associated with increased risk of incident mobility and ADL difficulty. Rehabilitation and adaptive environmental changes for individuals living with DSI may be important to maximize mobility and daily function.
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Affiliation(s)
- Nicole M Armstrong
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Colby Gendron
- Department of Economics, Brown University, Providence, Rhode Island, USA
| | - Willa D Brenowitz
- Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bonnelin Swenor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins Disability Health Research Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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13
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Brenowitz WD, Eastman JA, Leng Y, Yaffe K. Does inflammation explain the link between multiple sensory impairment and dementia? Alzheimers Dement 2021. [DOI: 10.1002/alz.055829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Yue Leng
- University of California, San Francisco San Francisco CA USA
| | - Kristine Yaffe
- University of California San Francisco / San Francisco VA Medical Center San Francisco CA USA
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14
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Eastman JA, Yaffe K, Kerlikowske K, Brenowitz WD, Kornblith ES, Inslicht S. Personal history of breast cancer, cognitive function, and conversion in women from the ADNI cohort. Alzheimers Dement 2021. [DOI: 10.1002/alz.057544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jennifer Ann Eastman
- San Francisco VA Health Care System San Francisco CA USA
- University of California, San Francisco San Francisco CA USA
| | - Kristine Yaffe
- Department of Epidemiology & Biostatistics, University of California San Francisco San Francisco CA USA
| | - Karla Kerlikowske
- San Francisco VA Health Care System San Francisco CA USA
- University of California, San Francisco San Francisco CA USA
| | | | - Erica S Kornblith
- San Francisco VA Health Care System San Francisco CA USA
- University of California, San Francisco San Francisco CA USA
| | - Sabra Inslicht
- San Francisco VA Health Care System San Francisco CA USA
- University of California, San Francisco San Francisco CA USA
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15
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Brenowitz WD. Invited Commentary: Body Mass Index and Risk of Dementia-Potential Explanations for Life-Course Differences in Risk Estimates and Future Research Directions. Am J Epidemiol 2021; 190:2511-2514. [PMID: 33831175 DOI: 10.1093/aje/kwab095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
The relationship between body mass index (BMI) and health outcomes of older adults, including dementia, remains controversial. Many studies find inverse associations between BMI and dementia among older adults, while in other studies high BMI in midlife is associated with increased dementia risk. In this issue, Li et al. (Am J Epidemiol. 2021;190(12):2503-2510) examine BMI from mid- to late life and risk of dementia using the extensive follow-up of the Framingham Offspring Study. They found changing trends in the association between BMI and dementia from a positive association for midlife (ages 40-49) to an inverse trend in late life. Their work demonstrates the importance of studying dementia risk factors across the life course. Midlife obesity might be an important modifiable risk factor for dementia. However, because incipient dementia can lead to weight loss, reverse causation remains a key source of bias that could explain an inverse trend between BMI and dementia in older ages. The extent of other biases, including unmeasured confounding, inaccuracy of BMI as a measure for adiposity, or selective survival, are also unclear. Triangulating evidence on body composition and dementia risk could lead to better targets for dementia intervention, but future work will need to evaluate specific pathways.
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16
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Le JT, Agrón E, Keenan TDL, Clemons TE, Brenowitz WD, Yaffe K, Chew EY. Assessing bidirectional associations between cognitive impairment and late age-related macular degeneration in the Age-Related Eye Disease Study 2. Alzheimers Dement 2021; 18:1296-1305. [PMID: 34758100 DOI: 10.1002/alz.12473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/06/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION We aimed to investigate bidirectional associations between cognitive impairment and late age-related macular degeneration (AMD). METHODS Participants in the Age-Related Eye Disease Study 2 (AREDS2) received annual eye examinations and cognitive function testing (e.g., Modified Telephone Interview for Cognitive Status [TICS-M]). We examined bidirectional associations between cognitive impairment (e.g., a TICS-M score < 30) and late AMD at 5 and 10 years. RESULTS Five thousand one hundred eighty-nine eyes (3157 participants; mean age 72.7 years) were analyzed and followed for a median of 10.4 years. Eyes of participants with cognitive impairment at baseline were more likely to progress to late AMD at 5 years (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.08-1.43) and 10 years (HR, 1.20; 95% CI, 1.05-1.37) than eyes of participants without cognitive impairment. Worse baseline AMD severity was not associated with developing cognitive impairment. DISCUSSION Cognitive impairment is associated with late AMD progression in AREDS2. Our finding highlights the importance of eyecare for people with cognitive impairment.
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Affiliation(s)
- Jimmy T Le
- Division of Epidemiology and Clinical Applications & Division of Extramural Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Tiarnan D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Willa D Brenowitz
- Departments of Psychiatry and Behavioral Science, Neurology, and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Kristine Yaffe
- Department of Neurology, University of California San Francisco, San Francisco, San Francisco, California, USA.,Departments of Psychiatry and Behavioral Science, Neurology, and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
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17
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Powell DS, Brenowitz WD, Yaffe K, Armstrong NM, Reed NS, Lin FR, Gross AL, Deal JA. Examining the Combined Estimated Effects of Hearing Loss and Depressive Symptoms on Risk of Cognitive Decline and Incident Dementia. J Gerontol B Psychol Sci Soc Sci 2021; 77:839-849. [PMID: 34655295 DOI: 10.1093/geronb/gbab194] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Late-life depression is a comorbidity which may co-occur in older adults with hearing loss- each as prevalent and independent modifiable risk factors for dementia. METHODS Using data from 1,820 Health Aging and Body Composition Study participants (74 ± 2.8 years, 38% Black race), we compared the hearing loss-dementia/cognitive decline relationship between those with normal hearing/mild hearing loss and those with moderate or greater hearing loss. Using linear mixed-effects and Cox proportional hazard models, we investigated if the associations between hearing loss and cognitive decline or dementia (Modified Mini Mental State Exam[3MS] and Digit Symbol Substitution[DSST]) differed by the presence or absence of depressive symptoms. Depressive symptoms were defined as CES-D 10 ≥10 at one or more visits from years 1-5. Algorithmic incident dementia was defined using medication use, hospitalizations and cognitive test scores. Audiometric hearing loss was measured at year 5 and categorized as normal/mild vs ≥moderate loss. RESULTS Having both hearing loss and depressive symptoms (vs. having neither) was associated with faster rates of decline in 3MS (β=-0.30, 95% Confidence Interval, [CI]:-0.78, -0.19) and DSST (β=-0.35,95% CI:-0.67, -0.03) over 10 years of follow-up. Having both hearing loss and depressive symptoms (vs. neither) was associated with increased risk (hazard ratio (HR):2.91, 95%CI: 1.59, 5.33 vs. HR:1.54,95%CI: 1.10,2.15 hearing loss only and HR:2.35,95%CI: 1.56,3.53 depressive symptoms only) of incident dementia in multivariable-adjusted Cox proportional hazards models. DISCUSSION Comorbid conditions among hearing impaired older adults should be considered and may aid in dementia prevention and management strategies.
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Affiliation(s)
- Danielle S Powell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
| | - Willa D Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA.,Department of Neurology, University of California, San Francisco, USA
| | - Nicole M Armstrong
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA.,Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA.,Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA.,Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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18
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Brenowitz WD, Zimmerman SC, Filshtein TJ, Yaffe K, Walter S, Hoffmann TJ, Jorgenson E, Whitmer RA, Glymour MM. Extension of Mendelian Randomization to Identify Earliest Manifestations of Alzheimer Disease: Association of Genetic Risk Score for Alzheimer Disease With Lower Body Mass Index by Age 50 Years. Am J Epidemiol 2021; 190:2163-2171. [PMID: 33843952 DOI: 10.1093/aje/kwab103] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Weight loss or lower body mass index (BMI) could be an early symptom of Alzheimer disease (AD), but when this begins to emerge is difficult to estimate with traditional observational data. In an extension of Mendelian randomization, we leveraged variation in genetic risk for late-onset AD risk to estimate the causal effect of AD on BMI and the earliest ages at which AD-related weight loss (or lower BMI as a proxy) occurs. We studied UK Biobank participants enrolled in 2006-2010, who were without dementia, aged 39-73, with European genetic ancestry. BMI was calculated with measured height/weight (weight (kg)/height (m)2). An AD genetic risk score (AD-GRS) was calculated based on 23 genetic variants. Using linear regressions, we tested the association of AD-GRS with BMI, stratified by decade, and calculated the age of divergence in BMI trends between low and high AD-GRS. AD-GRS was not associated with BMI in 39- to 49-year-olds (β = 0.00, 95% confidence interval (CI): -0.03, 0.03). AD-GRS was associated with lower BMI in 50- to 59-year-olds (β = -0.03, 95% CI: -0.06, -0.01) and 60- to 73-year-olds (β = -0.09, 95% CI:-0.12, -0.07). Model-based BMI age curves for high versus low AD-GRS began to diverge after age 47 years. Sensitivity analyses found no evidence for pleiotropy or survival bias. Longitudinal replication is needed; however, our findings suggest that AD genes might begin to reduce BMI decades prior to dementia diagnosis.
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19
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Ospina-Romero M, Brenowitz WD, Glymour MM, Mayeda ER, Graff RE, Witte JS, Ackley S, Lu KP, Kobayashi LC. The Association Between Cancer and Spousal Rate of Memory Decline: A Negative Control Study to Evaluate (Unmeasured) Social Confounding of the Cancer-memory Relationship. Alzheimer Dis Assoc Disord 2021; 35:271-274. [PMID: 32568784 PMCID: PMC7749066 DOI: 10.1097/wad.0000000000000398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/25/2020] [Indexed: 11/26/2022]
Abstract
Cancer diagnoses are associated with better long-term memory in older adults, possibly reflecting a range of social confounders that increase cancer risk but improve memory. We used spouse's memory as a negative control outcome to evaluate this possible confounding, since spouses share social characteristics and environments, and individuals' cancers are unlikely to cause better memory among their spouses. We estimated the association of an individual's incident cancer diagnosis (exposure) with their own (primary outcome) and their spouse's (negative control outcome) memory decline in 3601 couples from 1998 to 2014 in the Health and Retirement Study, using linear mixed-effects models. Incident cancer predicted better long-term memory for the diagnosed individual. We observed no association between an individual's cancer diagnosis and rate of spousal memory decline. This negative control study suggests that the inverse association between incident cancer and rate of memory decline is unlikely to be attributable to social/behavioral factors shared between spouses.
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Affiliation(s)
- Monica Ospina-Romero
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Willa D. Brenowitz
- Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Elizabeth R. Mayeda
- Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Rebecca E. Graff
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - John S. Witte
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Sarah Ackley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Kun Ping Lu
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Lindsay C. Kobayashi
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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20
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Ackley SF, Hayes-Larson E, Brenowitz WD, Swinnerton K, Mungas D, Fletcher E, Singh B, Whitmer RA, DeCarli C, Maria Glymour M. Amyloid-PET imaging offers small improvements in predictions of future cognitive trajectories. Neuroimage Clin 2021; 31:102713. [PMID: 34153689 PMCID: PMC8233225 DOI: 10.1016/j.nicl.2021.102713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/05/2021] [Accepted: 05/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Amyloid β (Aβ) is thought to initiate a cascade of pathology culminating in Alzheimer's disease-related cognitive decline. Aβ accumulation in brain tissues may begin one to two decades prior to clinical diagnosis of Alzheimer's disease. Prior studies have demonstrated that Aβ detected in vivo with positron emission tomography with amyloid ligands (amyloid-PET) predicts contemporaneously measured cognition and future cognitive trajectories. Prior studies have not evaluated the added value of Aβ measures in predicting future cognition when repeated past cognitive measures are available. We evaluated the extent to which amyloid-PET improves prediction of future cognitive changes over and above predictions based only on sociodemographics and past cognitive measures. METHODS We used data from participants in the University of California Davis Alzheimer's Disease Research cohort who were cognitively normal at baseline, participated in amyloid-PET imaging, and completed at least three cognitive assessments prior to amyloid-PET imaging (N = 132 for memory andN = 135 for executive function). We used sociodemographic and cognitive measures taken prior to amyloid-PET imaging to predict cognitive trajectory after amyloid-PET imaging and assessed whether measures of amyloid burden improved predictions of subsequent cognitive change. Improvements in prediction were characterized as percent reduction in the mean squared error (MSE) in predicted cognition post amyloid-PET and increase in percent variance explained. RESULTS The base model using only sociodemographics and past cognitive performance explained the majority of variance in both predicted memory measures (55.6%) and executive function measures (74.5%) following amyloid-PET. Adding amyloid positivity to the model reduced the MSE for memory by 0.2%, 95% CI: (0%, 2.6%), p = 0.48 and for executive function by 3.4%, 95% CI: (0.6%, 10.2%), p = 0.002. This corresponded to an increase in the percent variance explained of 0.1%, 95% CI: (0%, 1.2%) for memory and 0.9%, 95% CI: (0.1%, 2.8%) for executive function. Similar results were obtained using a continuous measure of amyloid burden. CONCLUSION In this cohort, the addition of amyloid burden slightly improved predictions of executive function compared to models based only on past cognitive assessments and sociodemographics. When repeated cognitive assessments are available, the additional utility of amyloid-PET in predicting future cognitive impairment may be limited.
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Affiliation(s)
- Sarah F Ackley
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States
| | - Eleanor Hayes-Larson
- Department of Epidemiology, University of California Los Angeles, Fielding School of Public Health, United States
| | - Willa D Brenowitz
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States
| | - Kaitlin Swinnerton
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States
| | - Dan Mungas
- Department of Neurology, Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Evan Fletcher
- Department of Neurology, Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Baljeet Singh
- Department of Neurology, Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Rachel A Whitmer
- Kaiser Permanente Division of Research, Oakland, CA, United States; Department of Public Health Sciences, UC Davis, United States
| | - Charles DeCarli
- Department of Neurology, Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States.
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Brenowitz WD, Wallhagen MI. Does Hearing Impairment Affect Physical Function?: Current Evidence, Potential Mechanisms, and Future Research Directions for Healthy Aging. JAMA Netw Open 2021; 4:e2114782. [PMID: 34170308 DOI: 10.1001/jamanetworkopen.2021.14782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Willa D Brenowitz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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22
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Vu TA, Fenwick EK, Gan ATL, Man REK, Tan BKJ, Gupta P, Ho KC, Reyes-Ortiz CA, Trompet S, Gussekloo J, O'Brien JM, Mueller-Schotte S, Wong TY, Tham YC, Cheng CY, Lee ATC, Rait G, Swenor BK, Varadaraj V, Brenowitz WD, Medeiros FA, Naël V, Narasimhalu K, Chen CLH, Lamoureux EL. The Bidirectional Relationship between Vision and Cognition: A Systematic Review and Meta-analysis. Ophthalmology 2021; 128:981-992. [PMID: 33333104 DOI: 10.1016/j.ophtha.2020.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/21/2022] Open
Abstract
TOPIC Visual impairment (VI) and cognitive impairment (CIM) are prevalent age-related conditions that impose substantial burden on the society. Findings on the hypothesized bidirectional association of VI and CIM remains equivocal. Hence, we conducted a systematic review and meta-analysis to examine this bidirectional relationship. CLINICAL RELEVANCE Sixty percent risk of CIM has not been well elucidated in the literature. A bidirectional relationship between VI and CIM may support the development of strategies for early detection and management of risk factors for both conditions in older people. METHODS PubMed, Embase, and Cochrane Central registers were searched systematically for observational studies, published from inception until April 6, 2020, in adults 40 years of age or older reporting objectively measured VI and CIM assessment using clinically validated cognitive screening tests or diagnostic evaluation. Meta-analyses on cross-sectional and longitudinal associations between VI and CIM outcomes (any CIM assessed using screening tests and clinically diagnosed dementia) were examined. Random effect models were used to generate pooled odds ratios (ORs) and 95% confidence intervals (CIs). We also examined study quality, publication bias, and heterogeneity. RESULTS Forty studies were included (n = 47 913 570). Meta-analyses confirmed that persons with VI were more likely to have CIM, with significantly higher odds of: (1) any CIM (cross-sectional: OR, 2.38 [95% CI, 1.84-3.07]; longitudinal: OR, 1.66 [95% CI, 1.46-1.89]) and (2) clinically diagnosed dementia (cross-sectional: OR, 2.43 [95% CI, 1.48-4.01]; longitudinal: OR, 2.09 [95% CI, 1.37-3.21]) compared with persons without VI. Significant heterogeneity was explained partially by differences in age, sex, and follow-up duration. Also, some evidence suggested that individuals with CIM, relative to cognitively intact persons, were more likely to have VI, with most articles (8/9 [89%]) reporting significantly positive associations; however, meta-analyses on this association could not be conducted because of insufficient data. DISCUSSION Overall, our work suggests that VI is a risk factor of CIM, although further work is needed to confirm the association of CIM as a risk factor for VI. Strategies for early detection and management of both conditions in older people may minimize individual clinical and public health consequences.
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Affiliation(s)
- Tai Anh Vu
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Eva K Fenwick
- Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Alfred T L Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Ryan E K Man
- Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Benjamin K J Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Kam Chun Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; School of Optometry and Visual Science, University of New South Wales, Sydney, Australia; Injury Division, The George Institute for Global Health, Sydney, Australia
| | - Carlos A Reyes-Ortiz
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Agricultural and Mechanical University, Florida
| | - Stella Trompet
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Joan M O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sigrid Mueller-Schotte
- University Medical Center Utrecht, Utrecht, The Netherlands; University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Tien Yin Wong
- Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Ching-Yu Cheng
- Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Allen T C Lee
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Greta Rait
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Varshini Varadaraj
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Willa D Brenowitz
- Department of Psychiatry, University of California, San Francisco, California
| | - Felipe A Medeiros
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
| | - Virginie Naël
- Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Kaavya Narasimhalu
- Duke-NUS Medical School, Singapore, Republic of Singapore; National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Republic of Singapore
| | - Christopher L H Chen
- Memory Aging and Cognition Center, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Ecosse L Lamoureux
- Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Department of Ophthalmology, The University of Melbourne, Melbourne, Australia.
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Ackley SF, Zimmerman SC, Brenowitz WD, Tchetgen Tchetgen EJ, Gold AL, Manly JJ, Mayeda ER, Filshtein TJ, Power MC, Elahi FM, Brickman AM, Glymour MM. Effect of reductions in amyloid levels on cognitive change in randomized trials: instrumental variable meta-analysis. BMJ 2021; 372:n156. [PMID: 33632704 PMCID: PMC7905687 DOI: 10.1136/bmj.n156] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate trials of drugs that target amyloid to determine whether reductions in amyloid levels are likely to improve cognition. DESIGN Instrumental variable meta-analysis. SETTING 14 randomized controlled trials of drugs for the prevention or treatment of Alzheimer's disease that targeted an amyloid mechanism, identified from ClinicalTrials.gov. POPULATION Adults enrolled in randomized controlled trials of amyloid targeting drugs. Inclusion criteria for trials vary, but typically include adults aged 50 years or older with a diagnosis of mild cognitive impairment or Alzheimer's disease, and amyloid positivity at baseline. MAIN OUTCOME MEASURES Analyses included trials for which information could be obtained on both change in brain amyloid levels measured with amyloid positron emission tomography and change in at least one cognitive test score reported for each randomization arm. RESULTS Pooled results from the 14 randomized controlled trials were more precise than estimates from any single trial. The pooled estimate for the effect of reducing amyloid levels by 0.1 standardized uptake value ratio units was an improvement in the mini-mental state examination score of 0.03 (95% confidence interval -0.06 to 0.1) points. This study provides a web application that allows for the re-estimation of the results when new data become available and illustrates the magnitude of the new evidence that would be necessary to achieve a pooled estimate supporting the benefit of reducing amyloid levels. CONCLUSIONS Pooled evidence from available trials reporting both reduction in amyloid levels and change in cognition suggests that amyloid reduction strategies do not substantially improve cognition.
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Affiliation(s)
- Sarah F Ackley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA
| | - Scott C Zimmerman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA
| | - Willa D Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | | | - Audra L Gold
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G H Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
| | | | | | - Melinda C Power
- Department of Epidemiology, George Washington University, Milken Institute School of Public Health, Washington DC, USA
| | - Fanny M Elahi
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G H Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA
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Brenowitz WD, Al Hazzouri AZ, Vittinghoff E, Golden SH, Fitzpatrick AL, Yaffe K. Depressive Symptoms Imputed Across the Life Course Are Associated with Cognitive Impairment and Cognitive Decline. J Alzheimers Dis 2021; 83:1379-1389. [PMID: 34420969 PMCID: PMC9095065 DOI: 10.3233/jad-210588] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Depressive symptoms may increase risk for dementia, but findings are controversial because late-life depression may be a prodromal dementia symptom. Life course data on depression and dementia risk may clarify this association; however, data is limited. OBJECTIVE To impute adult depressive symptoms trajectories across adult life stages and estimate the association with cognitive impairment and decline. METHODS Using a pooled study of 4 prospective cohorts (ages 20-89), we imputed adult life course depressive symptoms trajectories based on Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and calculated time-weighted averages for early adulthood (ages 20-49), mid-life (ages 50-69), and late-life (ages 70-89) for 6,122 older participants. Adjusted pooled logistic and mixed-effects models estimated associations of imputed depressive symptoms with two cognitive outcomes: cognitive impairment defined by established criteria and a composite cognitive score. RESULTS In separate models, elevated depressive symptoms in each life stage were associated with cognitive outcomes: early adulthood OR for cognitive impairment = 1.59 (95%CI: 1.35,1.87); mid-life OR = 1.94 (95%CI:1.16, 3.26); and late-life OR = 1.77 (95%CI:1.42, 2.21). When adjusted for depressive symptoms in the other life-stages, elevated depressive symptoms in early adulthood (OR = 1.73; 95%CI: 1.42,2.11) and late-life (OR = 1.43; 95%CI: 1.08,1.89) remained associated with cognitive impairment and were also associated with faster rates of cognitive decline (p < 0.05). CONCLUSION Imputing depressive symptom trajectories from pooled cohorts may help expand data across the life course. Our findings suggest early adulthood depressive symptoms may be a risk factor for cognitive impairment independent of mid- or late-life depressive symptoms.
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Affiliation(s)
- Willa D. Brenowitz
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA
| | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA
| | - Sherita H. Golden
- Department of Medicine Johns Hopkins University School of Medicine and Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Annette L. Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, School of Public Health, University of Washington, WA, USA
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, CA, USA
- San Francisco VA Health Care System, San Francisco, CA, USA
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25
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Leng Y, Ackley SF, Glymour MM, Yaffe K, Brenowitz WD. Genetic risk of Alzheimer’s disease is linked to short sleep duration. Alzheimers Dement 2020. [DOI: 10.1002/alz.042459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yue Leng
- University of California, San Francisco San Francisco CA USA
| | - Sarah F Ackley
- University of California, San Francisco San Francisco CA USA
| | - M Maria Glymour
- University of California, San Francisco San Francisco CA USA
| | - Kristine Yaffe
- University of California San Francisco / San Francisco VA Medical Center San Francisco CA USA
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26
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Zimmerman SC, Ackley SF, Brenowitz WD, Graff RE, Glymour MM. Phenome‐wide associations with an Alzheimer’s disease genetic risk score in UK Biobank: Identifying early indicators of disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.040114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Sarah F Ackley
- University of California, San Francisco San Francisco CA USA
| | | | - Rebecca E Graff
- University of California, San Francisco San Francisco CA USA
| | - M Maria Glymour
- University of California, San Francisco San Francisco CA USA
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27
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George KM, Peterson R, Gilsanz P, Mayeda ER, Mungas DM, Glymour MM, Brenowitz WD, Whitmer RA. Sensory impairments and cognition in a diverse cohort: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study. Alzheimers Dement 2020. [DOI: 10.1002/alz.046211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Paola Gilsanz
- Kaiser Permanente Division of Research Oakland CA USA
| | - Elizabeth Rose Mayeda
- University of California Los Angeles Fielding School of Public Health Los Angeles CA USA
| | - Dan M Mungas
- University of California, Davis Sacramento CA USA
| | - M Maria Glymour
- University of California, San Francisco San Francisco CA USA
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28
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Brenowitz WD, Robbins NM, Strotmeyer ES, Yaffe K. Peripheral nerve function and dementia in older adults with and without diabetes. Alzheimers Dement 2020. [DOI: 10.1002/alz.041377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Kristine Yaffe
- Global Brain Health Institute University of California San Francisco San Francisco CA USA
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29
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Ackley SF, Rist PM, Brenowitz WD, Graff RE, Glymour MM. The association between migraine genetic risk and dementia: A Mendelian randomization study. Alzheimers Dement 2020. [DOI: 10.1002/alz.045405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sarah F. Ackley
- University of California, San Francisco San Francisco CA USA
| | - Pamela M. Rist
- Brigham and Women’s Hospital and Harvard Medical School Boston MA USA
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30
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Teylan M, Schwabe‐Fry K, Hughes TM, Besser LM, Brenowitz WD, Keene CD, Gauthreaux K, Culhane JE, Miller Z, Chen Y, Chan KCG, Mock C, Kukull WA. Cognitive performance among participants with Alzheimer’s disease and cerebral amyloid angiopathy. Alzheimers Dement 2020. [DOI: 10.1002/alz.043853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Merilee Teylan
- National Alzheimer's Coordinating Center University of Washington Seattle WA USA
| | - Kristen Schwabe‐Fry
- National Alzheimer's Coordinating Center University of Washington Seattle WA USA
| | | | | | | | | | - Kathryn Gauthreaux
- National Alzheimer's Coordinating Center University of Washington Seattle WA USA
| | - Jessica E. Culhane
- National Alzheimer's Coordinating Center University of Washington Seattle WA USA
| | - Zachary Miller
- National Alzheimer's Coordinating Center University of Washington Seattle WA USA
| | - Yen‐Chi Chen
- National Alzheimer's Coordinating Center University of Washington Seattle WA USA
| | - Kwun Chuen Gary Chan
- National Alzheimer's Coordinating Center University of Washington Seattle WA USA
| | - Charles Mock
- National Alzheimer's Coordinating Center University of Washington Seattle WA USA
| | - Walter A. Kukull
- National Alzheimer's Coordinating Center University of Washington Seattle WA USA
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Brenowitz WD, Hazzouri AZA, Vittinghoff E, Matthews KA, Golden SH, Fitzpatrick AL, Yaffe K. Depressive symptoms modeled across the life‐course are associated with higher risk of dementia and cognitive decline: A pooled cohort analysis. Alzheimers Dement 2020. [DOI: 10.1002/alz.038053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | - Kristine Yaffe
- Global Brain Health Institute University of California San Francisco San Francisco CA USA
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32
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Brenowitz WD, Filshtein TJ, Yaffe K, Walter S, Ackley SF, Hoffmann T, Jorgenson E, Whitmer RA, Glymour MM. Functional hearing loss as a marker for early Alzheimer’s disease and dementia: Exploring the potential for reverse causation. Alzheimers Dement 2020. [DOI: 10.1002/alz.042881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Kristine Yaffe
- Global Brain Health Institute University of California San Francisco San Francisco CA USA
| | | | - Sarah F Ackley
- University of California, San Francisco San Francisco CA USA
| | - Thomas Hoffmann
- University of California, San Francisco San Francisco CA USA
| | | | | | - M Maria Glymour
- University of California, San Francisco San Francisco CA USA
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33
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Ospina-Romero M, Glymour MM, Hayes-Larson E, Mayeda ER, Graff RE, Brenowitz WD, Ackley SF, Witte JS, Kobayashi LC. Association Between Alzheimer Disease and Cancer With Evaluation of Study Biases: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2025515. [PMID: 33185677 PMCID: PMC7666424 DOI: 10.1001/jamanetworkopen.2020.25515] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Observational studies consistently report inverse associations between cancer and Alzheimer disease (AD). Shared inverse etiological mechanisms might explain this phenomenon, but a systematic evaluation of methodological biases in existing studies is needed. OBJECTIVES To systematically review and meta-analyze evidence on the association between cancer and subsequent AD, systematically identify potential methodological biases in studies, and estimate the influence of these biases on the estimated pooled association between cancer and AD. DATA SOURCES All-language publications were identified from PubMed, Embase, and PsycINFO databases through September 2, 2020. STUDY SELECTION Longitudinal cohort studies and case-control studies on the risk of AD in older adults with a history of any cancer type, prostate cancer, breast cancer, colorectal cancer, or nonmelanoma skin cancer, relative to those with no cancer history. DATA EXTRACTION AND SYNTHESIS Two reviewers independently abstracted the data and evaluated study biases related to confounding, diagnostic bias, competing risks, or survival bias. Random-effects meta-analysis was used to provide pooled estimates of the association between cancer and AD. Metaregressions were used to evaluate whether the observed pooled estimate could be attributable to each bias. The study was designed and conducted according to the Preferring Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES Incidence, hazard, or odds ratios for AD comparing older adults with vs without a previous cancer diagnosis. RESULTS In total, 19 cohort studies and 3 case-control studies of the associations between any cancer type (n = 13), prostate cancer (n = 5), breast cancer (n = 1), and nonmelanoma skin cancer (n = 3) with AD were identified, representing 9 630 435 individuals. In all studies combined, cancer was associated with decreased AD incidence (cohort studies: random-effects hazard ratio, 0.89; 95% CI, 0.79-1.00; case-control studies: random-effects odds ratio, 0.75; 95% CI, 0.61-0.93). Studies with insufficient or inappropriate confounder control or greater likelihood of AD diagnostic bias had mean hazard ratios closer to the null value, indicating that these biases could not explain the observed inverse association. Competing risks bias was rare. Studies with greater likelihood of survival bias had mean hazard ratios farther from the null value. CONCLUSIONS AND RELEVANCE The weak inverse association between cancer and AD may reflect shared inverse etiological mechanisms or survival bias but is not likely attributable to diagnostic bias, competing risks bias, or insufficient or inappropriate control for potential confounding factors.
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Affiliation(s)
- Monica Ospina-Romero
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- now at Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Eleanor Hayes-Larson
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Rebecca E. Graff
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Sarah F. Ackley
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - John S. Witte
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Lindsay C. Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
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Brenowitz WD, Filshtein TJ, Yaffe K, Walter S, Ackley SF, Hoffmann TJ, Jorgenson E, Whitmer RA, Glymour MM. Association of genetic risk for Alzheimer disease and hearing impairment. Neurology 2020; 95:e2225-e2234. [PMID: 32878991 PMCID: PMC7713783 DOI: 10.1212/wnl.0000000000010709] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/12/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To test the hypothesis that incipient Alzheimer disease (AD) may adversely affect hearing and that hearing loss may adversely affect cognition, we evaluated whether genetic variants that increase AD risk also increase problem hearing and genetic variants that increase hearing impairment risk do not influence cognition. METHODS UK Biobank participants without dementia ≥56 years of age with Caucasian genetic ancestry completed a Digit Triplets Test of speech-in-noise hearing (n = 80,074), self-reported problem hearing and hearing with background noise (n = 244,915), and completed brief cognitive assessments. A genetic risk score for AD (AD-GRS) was calculated as a weighted sum of 23 previously identified AD-related polymorphisms. A genetic risk score for hearing (hearing-GRS) was calculated using 3 previously identified polymorphisms related to hearing impairment. Using age-, sex-, and genetic ancestry-adjusted logistic and linear regression models, we evaluated whether the AD-GRS predicted poor hearing and whether the hearing-GRS predicted worse cognition. RESULTS Poor speech-in-noise hearing (>-5.5-dB speech reception threshold; prevalence 14%) was associated with lower cognitive scores (ß = -1.28; 95% confidence interval [CI] -1.54 to -1.03). Higher AD-GRS was significantly associated with poor speech-in-noise hearing (odds ratio [OR] 1.06; 95% CI 1.01-1.11) and self-reported problems hearing with background noise (OR 1.03; 95% CI 1.00-1.05). Hearing-GRS was not significantly associated with cognitive scores (ß = -0.05; 95% CI -0.17 to 0.07). CONCLUSIONS Genetic risk for AD also influences speech-in-noise hearing. We failed to find evidence that genetic risk for hearing impairment affects cognition. AD disease processes or a that shared etiology may cause speech-in-noise difficulty before dementia onset.
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Affiliation(s)
- Willa D Brenowitz
- From the Department of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Department of Epidemiology and Biostatistics (K.Y., S.F.A., T.J.H., M.M.G.), Department of Neurology (K.Y.), and Institute for Human Genetics (T.J.H.), University of California, San Francisco; 23andMe (T.J.F.), Mountain View; San Francisco VA Health Care System (K.Y.), CA; Department of Medicine and Public Health (S.W.), Rey Juan Carlos University, Madrid, Spain; Kaiser Permanente Northern California Division of Research (E.J.), Oakland; and Public Health Sciences (R.A.W.), Division of Epidemiology, Alzheimer's Disease Research Center, UC Davis School of Medicine, CA.
| | - Teresa J Filshtein
- From the Department of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Department of Epidemiology and Biostatistics (K.Y., S.F.A., T.J.H., M.M.G.), Department of Neurology (K.Y.), and Institute for Human Genetics (T.J.H.), University of California, San Francisco; 23andMe (T.J.F.), Mountain View; San Francisco VA Health Care System (K.Y.), CA; Department of Medicine and Public Health (S.W.), Rey Juan Carlos University, Madrid, Spain; Kaiser Permanente Northern California Division of Research (E.J.), Oakland; and Public Health Sciences (R.A.W.), Division of Epidemiology, Alzheimer's Disease Research Center, UC Davis School of Medicine, CA
| | - Kristine Yaffe
- From the Department of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Department of Epidemiology and Biostatistics (K.Y., S.F.A., T.J.H., M.M.G.), Department of Neurology (K.Y.), and Institute for Human Genetics (T.J.H.), University of California, San Francisco; 23andMe (T.J.F.), Mountain View; San Francisco VA Health Care System (K.Y.), CA; Department of Medicine and Public Health (S.W.), Rey Juan Carlos University, Madrid, Spain; Kaiser Permanente Northern California Division of Research (E.J.), Oakland; and Public Health Sciences (R.A.W.), Division of Epidemiology, Alzheimer's Disease Research Center, UC Davis School of Medicine, CA
| | - Stefan Walter
- From the Department of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Department of Epidemiology and Biostatistics (K.Y., S.F.A., T.J.H., M.M.G.), Department of Neurology (K.Y.), and Institute for Human Genetics (T.J.H.), University of California, San Francisco; 23andMe (T.J.F.), Mountain View; San Francisco VA Health Care System (K.Y.), CA; Department of Medicine and Public Health (S.W.), Rey Juan Carlos University, Madrid, Spain; Kaiser Permanente Northern California Division of Research (E.J.), Oakland; and Public Health Sciences (R.A.W.), Division of Epidemiology, Alzheimer's Disease Research Center, UC Davis School of Medicine, CA
| | - Sarah F Ackley
- From the Department of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Department of Epidemiology and Biostatistics (K.Y., S.F.A., T.J.H., M.M.G.), Department of Neurology (K.Y.), and Institute for Human Genetics (T.J.H.), University of California, San Francisco; 23andMe (T.J.F.), Mountain View; San Francisco VA Health Care System (K.Y.), CA; Department of Medicine and Public Health (S.W.), Rey Juan Carlos University, Madrid, Spain; Kaiser Permanente Northern California Division of Research (E.J.), Oakland; and Public Health Sciences (R.A.W.), Division of Epidemiology, Alzheimer's Disease Research Center, UC Davis School of Medicine, CA
| | - Thomas J Hoffmann
- From the Department of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Department of Epidemiology and Biostatistics (K.Y., S.F.A., T.J.H., M.M.G.), Department of Neurology (K.Y.), and Institute for Human Genetics (T.J.H.), University of California, San Francisco; 23andMe (T.J.F.), Mountain View; San Francisco VA Health Care System (K.Y.), CA; Department of Medicine and Public Health (S.W.), Rey Juan Carlos University, Madrid, Spain; Kaiser Permanente Northern California Division of Research (E.J.), Oakland; and Public Health Sciences (R.A.W.), Division of Epidemiology, Alzheimer's Disease Research Center, UC Davis School of Medicine, CA
| | - Eric Jorgenson
- From the Department of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Department of Epidemiology and Biostatistics (K.Y., S.F.A., T.J.H., M.M.G.), Department of Neurology (K.Y.), and Institute for Human Genetics (T.J.H.), University of California, San Francisco; 23andMe (T.J.F.), Mountain View; San Francisco VA Health Care System (K.Y.), CA; Department of Medicine and Public Health (S.W.), Rey Juan Carlos University, Madrid, Spain; Kaiser Permanente Northern California Division of Research (E.J.), Oakland; and Public Health Sciences (R.A.W.), Division of Epidemiology, Alzheimer's Disease Research Center, UC Davis School of Medicine, CA
| | - Rachel A Whitmer
- From the Department of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Department of Epidemiology and Biostatistics (K.Y., S.F.A., T.J.H., M.M.G.), Department of Neurology (K.Y.), and Institute for Human Genetics (T.J.H.), University of California, San Francisco; 23andMe (T.J.F.), Mountain View; San Francisco VA Health Care System (K.Y.), CA; Department of Medicine and Public Health (S.W.), Rey Juan Carlos University, Madrid, Spain; Kaiser Permanente Northern California Division of Research (E.J.), Oakland; and Public Health Sciences (R.A.W.), Division of Epidemiology, Alzheimer's Disease Research Center, UC Davis School of Medicine, CA
| | - M Maria Glymour
- From the Department of Psychiatry and Behavioral Sciences (W.D.B., K.Y.), Department of Epidemiology and Biostatistics (K.Y., S.F.A., T.J.H., M.M.G.), Department of Neurology (K.Y.), and Institute for Human Genetics (T.J.H.), University of California, San Francisco; 23andMe (T.J.F.), Mountain View; San Francisco VA Health Care System (K.Y.), CA; Department of Medicine and Public Health (S.W.), Rey Juan Carlos University, Madrid, Spain; Kaiser Permanente Northern California Division of Research (E.J.), Oakland; and Public Health Sciences (R.A.W.), Division of Epidemiology, Alzheimer's Disease Research Center, UC Davis School of Medicine, CA
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Bock MA, Bahorik A, Brenowitz WD, Yaffe K. Apathy and risk of probable incident dementia among community-dwelling older adults. Neurology 2020; 95:e3280-e3287. [PMID: 33055276 DOI: 10.1212/wnl.0000000000010951] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the association between baseline apathy and probable incident dementia in a population-based sample of community-dwelling older adults. METHODS We studied 2,018 white and black community-dwelling older adults from the Health, Aging, and Body Composition (Health ABC) study. We measured apathy at year 6 (our study baseline) with the modified Apathy Evaluation Scale and divided participants into tertiles based on low, moderate, or severe apathy symptoms. Incident dementia was ascertained over 9 years by dementia medication use, hospital records, or clinically relevant cognitive decline on global cognition. We examined the association between apathy and probable incident dementia using a Cox proportional hazards model adjusting for demographics, cardiovascular risk factors, APOE4 status, and depressed mood. We also evaluated the association between the apathy group and cognitive change (as measured by the modified Mini-Mental State Examination and Digit Symbol Substitution Test over 5 years) using linear mixed effects models. RESULTS Over 9 years of follow-up, 381 participants developed probable dementia. Severe apathy was associated with an increased risk of dementia compared to low apathy (25% vs 14%) in unadjusted (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.5-2.5) and adjusted models (HR 1.7, 95% CI 1.3-2.2). Greater apathy was associated with worse cognitive score at baseline, but not rate of change over time. CONCLUSION In a diverse cohort of community-dwelling adults, apathy was associated with increased risk of developing probable dementia. This study provides novel evidence for apathy as a prodrome of dementia.
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Affiliation(s)
- Meredith A Bock
- From the Departments of Neurology (M.A.B., K.Y.), Psychiatry (A.B., W.D.B., K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (K.Y.), CA.
| | - Amber Bahorik
- From the Departments of Neurology (M.A.B., K.Y.), Psychiatry (A.B., W.D.B., K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
| | - Willa D Brenowitz
- From the Departments of Neurology (M.A.B., K.Y.), Psychiatry (A.B., W.D.B., K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
| | - Kristine Yaffe
- From the Departments of Neurology (M.A.B., K.Y.), Psychiatry (A.B., W.D.B., K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
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Leng Y, Ackley SF, Glymour MM, Yaffe K, Brenowitz WD. Genetic Risk of Alzheimer's Disease and Sleep Duration in Non-Demented Elders. Ann Neurol 2020; 89:177-181. [PMID: 32951248 DOI: 10.1002/ana.25910] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022]
Abstract
Growing evidence has suggested an association between sleep duration and Alzheimer's disease (AD), but it is unclear if sleep duration is a manifestation of the AD disease process. We studied whether genetic liability for AD predicts sleep duration using a genetic risk score (GRS) for AD (AD-GRS), in 406,536 UK Biobank participants with European ancestry and without dementia at enrollment. Higher AD-GRS score was associated with shorter sleep (b = -0.014, 95% confidence interval [CI] = -0.022 to -0.006), especially in those aged 55+. Using AD-GRS as an instrumental variable for AD diagnosis, incipient AD reduced sleep duration by 1.87 hours (95% CI = 0.96, 2.78). Short sleep duration might be an early marker of AD. ANN NEUROL 2021;89:177-181.
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Affiliation(s)
- Yue Leng
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Sarah F Ackley
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Maria M Glymour
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA.,Department of Neurology, University of California, San Francisco, San Francisco, CA.,San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | - Willa D Brenowitz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
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Brenowitz WD, Besser LM, Kukull WA, Keene CD, Glymour MM, Yaffe K. Clinician-judged hearing impairment and associations with neuropathologic burden. Neurology 2020; 95:e1640-e1649. [PMID: 32759190 PMCID: PMC7713726 DOI: 10.1212/wnl.0000000000010575] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/30/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To examine whether neuropathologic burden is associated with hearing impairment. METHODS We studied 2,755 autopsied participants ≥55 years of age from the National Alzheimer's Coordinating Center database. Participants had at least 1 clinical evaluation at US National Institute on Aging-funded Alzheimer's Disease Center no more than 2 years before death. Patients were classified as hearing impaired by clinician report at baseline. Common dementia neuropathologies included Alzheimer disease pathologic change (Consortium to Establish a Registry for Alzheimer's Disease neuritic plaque density, neurofibrillary degeneration Braak stage), Lewy body disease, gross infarcts, and microinfarcts. Logistic regression models predicted impaired hearing with adjustment for age at death, sex, race, education, center, and follow-up time. Relative risks were calculated with the use of marginal standardization. RESULTS Impaired hearing was common (32%). In participants who were cognitively normal at baseline (n = 580), impaired hearing was associated with higher Braak stage (relative risk [RR] 1.33 per 2-stage increase, 95% confidence interval [CI] 1.06-1.66) but not other pathologies. In participants with dementia (n = 2,175), impaired hearing was positively associated with microinfarcts (RR 1.18, 95% CI 1.00-1.39) and inversely associated with neuritic plaque density (RR 0.91 per score increase, 95% CI 0.85-0.99). Development of impaired hearing in those with cognitive impairment was associated with neocortical Lewy bodies (1.26, 95% CI 1.02-1.55). CONCLUSIONS Impaired hearing, reported before the onset of cognitive impairment, was associated with increased neurofibrillary tangle burden. Impaired hearing in those with cognitive impairment was associated with microinfarcts and neocortical Lewy bodies but not typical Alzheimer disease pathologic change. Functional hearing problems may be a preclinical marker of neurofibrillary neurodegeneration, although replication is needed.
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Affiliation(s)
- Willa D Brenowitz
- From the Departments of Psychiatry and Behavioral Sciences (W.D.B., K.Y.) and Neurology (K.Y.), Weill Institute for Neurosciences, and Department of Epidemiology & Biostatistics (M.M.G., K.Y.), University of California, San Francisco; Florida Atlantic University (L.M.B.), Institute for Human Health and Disease Intervention, School of Urban and Regional Planning, Boca Raton; National Alzheimer's Coordinating Center (W.A.K.), Department of Epidemiology, and Department of Pathology (C.D.K.), University of Washington, Seattle; and San Francisco VA Health Care System (K.Y.), CA.
| | - Lilah M Besser
- From the Departments of Psychiatry and Behavioral Sciences (W.D.B., K.Y.) and Neurology (K.Y.), Weill Institute for Neurosciences, and Department of Epidemiology & Biostatistics (M.M.G., K.Y.), University of California, San Francisco; Florida Atlantic University (L.M.B.), Institute for Human Health and Disease Intervention, School of Urban and Regional Planning, Boca Raton; National Alzheimer's Coordinating Center (W.A.K.), Department of Epidemiology, and Department of Pathology (C.D.K.), University of Washington, Seattle; and San Francisco VA Health Care System (K.Y.), CA
| | - Walter A Kukull
- From the Departments of Psychiatry and Behavioral Sciences (W.D.B., K.Y.) and Neurology (K.Y.), Weill Institute for Neurosciences, and Department of Epidemiology & Biostatistics (M.M.G., K.Y.), University of California, San Francisco; Florida Atlantic University (L.M.B.), Institute for Human Health and Disease Intervention, School of Urban and Regional Planning, Boca Raton; National Alzheimer's Coordinating Center (W.A.K.), Department of Epidemiology, and Department of Pathology (C.D.K.), University of Washington, Seattle; and San Francisco VA Health Care System (K.Y.), CA
| | - C Dirk Keene
- From the Departments of Psychiatry and Behavioral Sciences (W.D.B., K.Y.) and Neurology (K.Y.), Weill Institute for Neurosciences, and Department of Epidemiology & Biostatistics (M.M.G., K.Y.), University of California, San Francisco; Florida Atlantic University (L.M.B.), Institute for Human Health and Disease Intervention, School of Urban and Regional Planning, Boca Raton; National Alzheimer's Coordinating Center (W.A.K.), Department of Epidemiology, and Department of Pathology (C.D.K.), University of Washington, Seattle; and San Francisco VA Health Care System (K.Y.), CA
| | - M Maria Glymour
- From the Departments of Psychiatry and Behavioral Sciences (W.D.B., K.Y.) and Neurology (K.Y.), Weill Institute for Neurosciences, and Department of Epidemiology & Biostatistics (M.M.G., K.Y.), University of California, San Francisco; Florida Atlantic University (L.M.B.), Institute for Human Health and Disease Intervention, School of Urban and Regional Planning, Boca Raton; National Alzheimer's Coordinating Center (W.A.K.), Department of Epidemiology, and Department of Pathology (C.D.K.), University of Washington, Seattle; and San Francisco VA Health Care System (K.Y.), CA
| | - Kristine Yaffe
- From the Departments of Psychiatry and Behavioral Sciences (W.D.B., K.Y.) and Neurology (K.Y.), Weill Institute for Neurosciences, and Department of Epidemiology & Biostatistics (M.M.G., K.Y.), University of California, San Francisco; Florida Atlantic University (L.M.B.), Institute for Human Health and Disease Intervention, School of Urban and Regional Planning, Boca Raton; National Alzheimer's Coordinating Center (W.A.K.), Department of Epidemiology, and Department of Pathology (C.D.K.), University of Washington, Seattle; and San Francisco VA Health Care System (K.Y.), CA
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Edwards RD, Brenowitz WD, Portacolone E, Covinsky KE, Bindman A, Glymour MM, Torres JM. Difficulty and help with activities of daily living among older adults living alone with cognitive impairment. Alzheimers Dement 2020; 16:1125-1133. [PMID: 32588985 PMCID: PMC7416441 DOI: 10.1002/alz.12102] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/17/2019] [Accepted: 01/17/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION There is limited research on difficulties with activities of daily living (I/ADLs) among older adults living alone with cognitive impairment, including differences by race/ethnicity. METHODS For U.S. Health and Retirement Study (2000-2014) participants aged 55+ living alone with cognitive impairment (4,666 individuals; 9,091 observations), we evaluated I/ADL difficulty and help. RESULTS Among 4.3 million adults aged 55+ living alone with cognitive impairment, an estimated 46% reported an I/ADL difficulty; 72% reported not receiving help with an I/ADL. Women reported more difficulty than men. Compared to white women, black women were 22% more likely to report a difficulty without help, and Latina women were 36% more likely to report a difficulty with help. Among men, racial/ethnic differences in outcomes were not significant. Patterns of difficulty without help by race/ethnicity were similar among Medicaid beneficiaries. DISCUSSION Findings call for targeted efforts to support older adults living alone with cognitive impairment.
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Affiliation(s)
- Ryan D. Edwards
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Willa D. Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Elena Portacolone
- Institute for Health & Aging, University of California, San Francisco, California, USA
| | - Ken E. Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Andrew Bindman
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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Brenowitz WD, Kaup AR, Yaffe K. Incident dementia and faster rates of cognitive decline are associated with worse multisensory function summary scores. Alzheimers Dement 2020; 16:1384-1392. [PMID: 32657033 DOI: 10.1002/alz.12134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/20/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION We created a summary score for multiple sensory (multisensory) impairment and evaluated its association with dementia. METHODS We studied 1794 adults aged 70 to 79 who were dementia-free at enrollment and followed for up to 10 years in the Health, Aging, and Body Composition Study. The multisensory function score (0 to 12 points) was based on sample quartiles of objectively measured vision, hearing, smell, and touch summed overall. Risk of incident dementia and cognitive decline (measured by two cognitive tests) associated with the score were assessed in regression models adjusting for demographics and health conditions. RESULTS Dementia risk was 2.05 times higher (95% confidence interval [CI] 1.50-2.81) comparing "poor" to "good" multisensory score tertiles and 1.45 times higher comparing the "middle" to "good" tertiles (95% CI 1.09-1.91). Each point worse in the multisensory function score was associated with faster rates of cognitive decline (P < .05). CONCLUSIONS Worsening multisensory function, even at mild levels, was associated with accelerated cognitive aging.
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Affiliation(s)
- Willa D Brenowitz
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Allison R Kaup
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA.,The Neurology Center of Southern California, Carlsbad, California, USA.,San Francisco VA Health Care System, San Francisco, California, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA.,San Francisco VA Health Care System, San Francisco, California, USA.,Department of Epidemiology & Biostatistics and Neurology, University of California San Francisco, San Francisco, California, USA
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Hwang PH, Longstreth W, Brenowitz WD, Thielke SM, Lopez OL, Francis CE, DeKosky ST, Fitzpatrick AL. Dual sensory impairment in older adults and risk of dementia from the GEM Study. Alzheimers Dement (Amst) 2020; 12:e12054. [PMID: 32671180 PMCID: PMC7340796 DOI: 10.1002/dad2.12054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hearing and vision loss are independently associated with dementia, but the impact of dual sensory impairment (DSI) on dementia risk is not well understood. METHODS Self-reported measures of hearing and vision were taken from 2051 participants at baseline from the Gingko Evaluation of Memory Study. Dementia status was ascertained using standardized criteria. Cox models were used to estimate risk of dementia associated with number of sensory impairments (none, one, or two). RESULTS DSI was significantly associated with higher risk of all-cause dementia (hazard ratio [HR] = 1.86; 95% confidence interval [CI] = 1.25-2.76) and Alzheimer's disease (HR = 2.12; 95% CI = 1.34-3.36). Individually only visual impairment was independently associated with an increased risk of all-cause dementia (HR = 1.32; 95% CI = 1.02-1.71). DISCUSSION Older adults with DSI are at a significantly increased risk for dementia. Further studies are needed to evaluate whether treatments can modify this risk.
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Affiliation(s)
- Phillip H. Hwang
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - W.T. Longstreth
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Willa D. Brenowitz
- Department of PsychiatryUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Stephen M. Thielke
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWashingtonUSA
- Geriatric ResearchEducationand Clinical CenterPuget Sound VA Medical CenterSeattleWashingtonUSA
| | - Oscar L. Lopez
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | | | - Annette L. Fitzpatrick
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of Family MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
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Brenowitz WD, Manly JJ, Murchland AR, Nguyen TT, Liu SY, Glymour MM, Levine DA, Crowe M, Hohman TJ, Dufouil C, Launer LJ, Hedden T, Eng CW, Wadley VG, Howard VJ. State School Policies as Predictors of Physical and Mental Health: A Natural Experiment in the REGARDS Cohort. Am J Epidemiol 2020; 189:384-393. [PMID: 31595946 DOI: 10.1093/aje/kwz221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 09/11/2019] [Accepted: 09/19/2019] [Indexed: 12/28/2022] Open
Abstract
We used differences in state school policies as natural experiments to evaluate the joint influence of educational quantity and quality on late-life physical and mental health. Using US Census microsample data, historical measures of state compulsory schooling and school quality (term length, student-teacher ratio, and attendance rates) were combined via regression modeling on a scale corresponding to years of education (policy-predicted years of education (PPYEd)). PPYEd values were linked to individual-level records for 8,920 black and 14,605 white participants aged ≥45 years in the Reasons for Geographic and Racial Differences in Stroke study (2003-2007). Linear and quantile regression models estimated the association between PPYEd and Physical Component Summary (PCS) and Mental Component Summary (MCS) from the Short Form Health Survey. We examined interactions by race and adjusted for sex, birth year, state of residence at age 6 years, and year of study enrollment. Higher PPYEd was associated with better median PCS (β = 1.28, 95% confidence interval (CI): 0.40, 1.49) and possibly better median MCS (β = 0.46, 95% CI: -0.01, 0.94). Effect estimates were higher among black (vs. white) persons (PCS × race interaction, β = 0.22, 95% CI: -0.62, 1.05, and MCS × race interaction, β = 0.18; 95% CI: -0.08, 0.44). When incorporating both school quality and duration, this quasiexperimental analysis found mixed evidence for a causal effect of education on health decades later.
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Gauthreaux K, Bonnett TA, Besser LM, Brenowitz WD, Teylan M, Mock C, Chen YC, Chan KCG, Keene CD, Zhou XH, Kukull WA. Concordance of Clinical Alzheimer Diagnosis and Neuropathological Features at Autopsy. J Neuropathol Exp Neurol 2020; 79:465-473. [PMID: 32186726 PMCID: PMC7160616 DOI: 10.1093/jnen/nlaa014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/27/2019] [Indexed: 12/14/2022] Open
Abstract
It remains unclear what clinical features inform the accuracy of a clinical diagnosis of Alzheimer disease (AD). Data were obtained from the National Alzheimer's Coordinating Center to compare clinical and neuropathologic features among participants who did or did not have Alzheimer disease neuropathologic changes (ADNC) at autopsy. Participants (1854) had a clinical Alzheimer dementia diagnosis and ADNC at autopsy (Confirmed-AD), 204 participants had an AD diagnosis and no ADNC (AD-Mimics), and 253 participants had no AD diagnosis and ADNC (Unidentified-AD). Compared to Confirmed-AD participants, AD-Mimics had less severe cognitive impairment, while Unidentified-AD participants displayed more parkinsonian signs, depression, and behavioral problems. This study highlights the importance of developing a complete panel of biomarkers as a tool to inform clinical diagnoses, as clinical phenotypes that are typically associated with diseases other than AD may result in inaccurate diagnoses.
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Affiliation(s)
- Kathryn Gauthreaux
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
| | - Tyler A Bonnett
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, Maryland
| | - Lilah M Besser
- School of Urban and Regional Planning, Institute for Human Health and Disease Intervention, Florida Atlantic University, Boca Raton, Florida
| | - Willa D Brenowitz
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California
| | - Merilee Teylan
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
| | | | | | - Kwun C G Chan
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, Washington
| | - Xiao-Hua Zhou
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
| | - Walter A Kukull
- Department of Epidemiology, National Alzheimer’s Coordinating Center, University of Washington, Seattle, Washington
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Besser LM, Brenowitz WD, Park J, Tolea MI, Galvin JE. Intention to Screen for Alzheimer's Disease by Residential Locale. Int J Environ Res Public Health 2020; 17:E2261. [PMID: 32230914 PMCID: PMC7178144 DOI: 10.3390/ijerph17072261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 12/18/2022]
Abstract
A random digit dialing sample from Missouri (USA) was used to compare associations between psychosocial factors and Alzheimer's disease (AD) screening intention based on residential locale. Linear regression associations between demographics and five psychosocial constructs (dementia knowledge, perceived screening benefits, preventive health behaviors, perceived susceptibility, and self-efficacy) and screening intention were compared by residential locale. Participants (n = 932) had a mean age of 62 years (urban: n = 375; suburban: n = 319, rural: n = 238). African Americans more often lived in urban than suburban/rural neighborhoods, and more urban than suburban/rural residents reported insufficient income. Preventative health behaviors (e.g., dentist visits) were higher in urban and suburban versus rural participants. AD screening intention did not differ by residential locale. Among urban participants, self-efficacy to get screened was associated with screening intention. Among rural participants, dementia knowledge was associated with screening intention. Perceived screening benefits and perceived susceptibility to AD were associated with screening intention regardless of locale. Unlike urban participants, rural participants demonstrated greater screening intention with greater dementia knowledge. Our findings suggest that psychosocial factors associated with AD screening intention differ depending on residential locale. Strategies to increase dementia screening may need to account for regional variations to be maximally effective.
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Affiliation(s)
- Lilah M. Besser
- School of Urban and Regional Planning, Institute for Human Health and Disease Intervention, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Willa D. Brenowitz
- Department of Psychiatry, School of Medicine, University of California San Francisco, San Francisco, CA 94158, USA;
| | - Juyoung Park
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL 33431, USA;
| | - Magdalena I. Tolea
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (M.I.T.); (J.E.G.)
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (M.I.T.); (J.E.G.)
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Han F, Bonnett T, Brenowitz WD, Teylan MA, Besser LM, Chen YC, Chan G, Cao KG, Gao Y, Zhou XH. Estimating associations between antidepressant use and incident mild cognitive impairment in older adults with depression. PLoS One 2020; 15:e0227924. [PMID: 31951629 PMCID: PMC6968868 DOI: 10.1371/journal.pone.0227924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/02/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Previous studies have provided equivocal evidence of antidepressant use on subsequent cognitive impairment; this could be due to inconsistent modeling approaches. Our goals are methodological and clinical. We evaluate the impact of statistical modeling approaches on the associations between antidepressant use and risk of Mild Cognitive Impairment (MCI) in older adults with depression. METHODS 716 participants were enrolled. Our primary analysis employed a time-dependent Cox proportional hazards model. We also implemented two fixed-covariate proportional hazards models-one based on having ever used antidepressants during follow-up, and the other restricted to baseline use only. RESULTS Treating antidepressant use as a time-varying covariate, we found no significant association with incident MCI (HR = 0.92, 95% CI: 0.70, 1.20). In contrast, when antidepressant use was treated as a fixed covariate, we observed a significant association between having ever used antidepressants and lower risk of MCI (HR = 0.40, 95% CI: 0.28, 0.56). However, in the baseline-use only model, the association was non-significant (HR = 0.84, 95% CI: 0.60, 1.17). DISCUSSION Our results were dependent upon statistical models and suggest that antidepressant use should be modeled as a time-varying covariate. Using a robust time-dependent analysis, antidepressant use was not significantly associated with incident MCI among cognitively normal persons with depression.
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Affiliation(s)
- Fang Han
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Neurology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Tyler Bonnett
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, United States of America
| | - Willa D. Brenowitz
- Department of Psychiatry, University of California, San Francisco, California, United States of America
| | - Merilee A. Teylan
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Lilah M. Besser
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Yen-Chi Chen
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Gary Chan
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Ke-Gang Cao
- Department of Neurology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Department of Neurology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Hua Zhou
- Department of Biostatistics, Beijing International Center for Mathematical Research, Peking University, Beijing, China
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Zahodne LB, Sharifian N, Manly JJ, Sumner JA, Crowe M, Wadley VG, Howard VJ, Murchland AR, Brenowitz WD, Weuve J. Life course biopsychosocial effects of retrospective childhood social support and later-life cognition. Psychol Aging 2019; 34:867-883. [PMID: 31566397 PMCID: PMC6829036 DOI: 10.1037/pag0000395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Social support during childhood lays the foundation for social relationships throughout the life course and has been shown to predict a wide range of mental and physical health outcomes. Social support measured in late life is prospectively associated with better cognitive aging, but few studies have evaluated social support received earlier in the life course. We quantified the effects of childhood social support, reported retrospectively, on later-life cognitive trajectories and investigated biopsychosocial mechanisms underlying these associations. Latent growth curve models estimated 10-year cognitive trajectories in 8,538 participants (baseline ages 45-93; Mage = 63) in the REasons for Geographic And Racial Differences in Stroke (REGARDS) project. Independent of sociodemographics, childhood socioeconomic status, and household size, greater retrospective childhood social support was associated with better initial episodic memory, but not verbal fluency or cognitive change, in later adulthood. Associations with initial memory level were mediated by sociodemographic and psychosocial variables; specifically, those who reported greater childhood social support reported higher educational attainment and had better physical and emotional health in adulthood, which were each associated with better memory. These results provide support for broad and enduring effects of childhood social support on mental, physical, and cognitive health decades later. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Brenowitz WD, Filshtein TJ, Yaffe K, Walter S, Hoffmann T, Jorgenson E, Whitmer RA, Glymour M. O3-08-06: USING GENETIC INFORMATION TO IDENTIFY THE EARLIEST MANIFESTATIONS OF ALZHEIMER'S DISEASE: GENETIC RISK SCORE FOR ALZHEIMER'S DISEASE PREDICTS LOWER BMI BY AGE 58. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Kristine Yaffe
- University of California San Francisco; San Francisco VA Medical Center; San Francisco CA USA
| | | | - Thomas Hoffmann
- University of California, San Francisco; San Francisco CA USA
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Filshtein TJ, Brenowitz WD, Mayeda ER, Hohman TJ, Walter S, Jones RN, Elahi FM, Glymour MM. Reserve and Alzheimer's disease genetic risk: Effects on hospitalization and mortality. Alzheimers Dement 2019; 15:907-916. [PMID: 31327391 PMCID: PMC7049165 DOI: 10.1016/j.jalz.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 03/05/2019] [Accepted: 04/03/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Cognitive reserve predicts delayed diagnosis of Alzheimer's disease (AD) and faster postdiagnosis decline. The net impact of cognitive reserve, combining both prediagnosis and postdiagnosis risk, on adverse AD-related outcomes is unknown. We adopted a novel approach, using AD genetic risk scores (AD-GRS), to evaluate this. METHODS Using 242,959 UK Biobank participants age 56+ years, we evaluated whether cognitive reserve (operationalized as education) modified associations between AD-GRS and mortality or hospitalization (total count, fall-related, and urinary tract infection-related). RESULTS AD-GRS predicted mortality and hospitalization outcomes. Education did not modify AD-GRS effects on mortality, but had a nonsignificantly (interaction P = .10) worse effect on hospitalizations due to urinary tract infection or falls among low education (OR = 1.07 [95% CI: 1.02, 1.12]) than high education (OR = 1.01 [0.95, 1.07]) individuals. DISCUSSION Education did not convey differential survival advantages to individuals with higher genetic risk of AD, but may reduce hospitalization risk associated with AD genetic risk.
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Affiliation(s)
- Teresa Jenica Filshtein
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Willa D Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Timothy J Hohman
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology and Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stefan Walter
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA; Hospital Universitario de Getafe, Madrid, Spain
| | - Rich N Jones
- Department of Neurology, Brown University, Providence, RI, USA; Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Fanny M Elahi
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
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Abstract
IMPORTANCE Patients with a history of cancer, even nonfatal cancers, have lower subsequent Alzheimer disease incidence. An inverse biological link between carcinogenesis and neurodegeneration has been hypothesized, although survival and detection biases are possible explanations. OBJECTIVE To compare long-term memory trajectories before and after incident cancer with memory trajectories of similarly aged individuals not diagnosed with cancer. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included 14 583 US adults born before 1949 with no cancer history from the Health and Retirement Study. Biennial assessments were performed for up to 16 years from 1998 to 2014. Data analysis was performed from January 8 to October 5, 2018. EXPOSURES Self-reported physician diagnosis of any cancer (excluding nonmelanoma skin cancer) during follow-up. MAIN OUTCOMES AND MEASURES A composite memory score standardized to a mean (SD) of 0 (1) at baseline was based on immediate and delayed word-list recall and proxy assessments. The rate of memory change among people diagnosed with cancer during follow-up before and after diagnosis was compared with rate of memory change in individuals who remained cancer free during follow-up using linear mixed-effect models with random intercepts and slopes. RESULTS A total of 14 583 participants were included in the sample (mean [SD] age, 66.4 [10.4] years; 8453 [58.0%] female). The mean (SD) follow-up was 11.5 (5.1) years; 2250 had a cancer diagnosis during follow-up, and 12 333 had no cancer diagnosis during follow-up. The rate of memory decline in the decade before a cancer diagnosis was 10.5% (95% CI, 6.2%-14.9%), which was slower than memory decline in similarly aged cancer-free individuals. For individuals diagnosed at 75 years of age, mean memory function immediately before diagnosis was 0.096 SD units (95% CI, 0.060-0.133 SD units) higher compared with that among similarly aged cancer-free individuals. A new cancer diagnosis was associated with a short-term decline in memory of -0.058 (95% CI, -0.084 to -0.032) SD units compared with memory before diagnosis. After diagnosis, the rate of memory decline was 3.9% (95% CI, 0.9%-6.9%) slower in individuals with cancer than in those without a cancer diagnosis. CONCLUSIONS AND RELEVANCE In this study, older individuals who developed cancer had better memory and slower memory decline than did similarly aged individuals who remained cancer free. These findings support the possibility of a common pathologic process working in opposite directions in cancer and Alzheimer disease.
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Affiliation(s)
- Monica Ospina-Romero
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Ekland Abdiwahab
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Lindsay Kobayashi
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Teresa Filshtein
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Willa D Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Elizabeth R Mayeda
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Brenowitz WD, Kaup AR, Lin FR, Yaffe K. Multiple Sensory Impairment Is Associated With Increased Risk of Dementia Among Black and White Older Adults. J Gerontol A Biol Sci Med Sci 2019; 74:890-896. [PMID: 30452551 PMCID: PMC6521912 DOI: 10.1093/gerona/gly264] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Few studies have examined impairment in multiple senses (multisensory impairment) and risk of dementia in comparison to having a single or no sensory impairment. METHODS We studied 1,810 black and white nondemented participants from Health, Aging, and Body Composition (Health ABC) Study aged 70-79 years at enrollment. Sensory impairment was determined at our study baseline (Year 3-5 of Health ABC) using established cut points for vision (Bailey-Lovie visual acuity and Pelli-Robson contrast sensitivity test), hearing (audiometric testing), smell (12-item Cross-Cultural Smell Identification Test), and touch (peripheral nerve function tests). Incident dementia over 10 years of follow-up was based on hospitalization records, dementia medications, or at least 1.5 SD decline in Modified Mini-Mental State Examination score (race-specific). Cox proportional hazard models with adjustment for demographics, health behaviors, and health conditions evaluated the relationship between risk of dementia and increasing number of sensory impairments. RESULTS Sensory impairments were common: 28% had visual impairment, 35% had hearing loss, 22% had poor smell, 12% had touch insensitivity; 26% had more than two impairments, and 5.6% had more than three sensory impairments. Number of impairments was associated with risk of dementia in a graded fashion (p < .001). Compared to no sensory impairments, the adjusted hazard ratio was 1.49 (95% CI: 1.12, 1.98) for one sensory impairment, 1.91 (95% CI: 1.39, 2.63) for two sensory impairments, and 2.85 (95% CI: 1.88, 4.30) for more than three sensory impairments. CONCLUSIONS Multisensory impairment was strongly associated with increased risk of dementia. Although, the nature of this relationship needs further investigation, sensory function assessment in multiple domains may help identify patients at high risk of dementia.
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Affiliation(s)
- Willa D Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Allison R Kaup
- San Francisco VA Health Care System, California.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco
| | - Frank R Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, Maryland.,Department of Epidemiology.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco.,San Francisco VA Health Care System, California.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco.,Department of Neurology, University of California, San Francisco
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Brenowitz WD, Filshtein TJ, Hoffmann T, Yaffe K, Jorgenson E, Whitmer RA, Glymour M. O3‐02‐04: EVALUATING REVERSE CAUSATION BETWEEN DEMENTIA AND HEARING IMPAIRMENT USING A GENETIC RISK SCORE FOR ALZHEIMER'S DISEASE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | - Kristine Yaffe
- University of California, San FranciscoSan FranciscoCAUSA
| | | | | | - Maria Glymour
- University of California, San FranciscoSan FranciscoCAUSA
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